Veterans Affairs, Defense expand their two-way health data system

Doctors in the Defense and Veterans Affairs departments' hospitals will soon be able to view patients' medical histories from their first examination to their latest checkup, regardless of which department holds the records.

With the launch of the Bi-directional Health Information Exchange, VA and Defense Department medical centers are transferring service members' data in real-time.

VA and DOD unveiled the first iteration of the two-way system in October at the Madigan Army Medical Center in Tacoma, Wash., and the Puget Sound VA Medical Center in Seattle and extended it this year in facilities in El Paso, Texas.

The goal is to develop interoperable electronic health records and data repositories. 'Any piece of information on a patient that is seen in either organization will be available to the providers seeing the patient in the other organization,' said Col. Bart Harmon, Army chief medical officer and deputy director in the Office of Information Management, Technology and Re-engineering in Falls Church, Va.

The flow of information had been one-way, following soldiers leaving the military into the VA system. Now, bidirectional sharing of health data will provide VA and DOD physicians with the most comprehensive picture of their patients.

For example, a VA physician pulled data from DOD's health repository to compare a patient's X-ray reports, and determined that a spot found on the patient's lung had not changed since it was first identified years ago, when he was a soldier.

Without access to the data stored by the DOD provider, the veteran would have had to undergo more tests and possible surgery, said Greg Dunham, VA's interagency program director for the Bi-directional Health Information Exchange, Office of Information Technology, in Bay Pines, Fla. Instead, doctors will continue to watch the condition.

More data coming

When VA and DOD launched the two-way information exchange in October, the facilities only could access outpatient pharmacy data, food and drug allergy data, and patient identification protocols.

Dunham said the next cycle of data includes lab re- sults and radiology text reports, which the project team has implemented in the Washington State facilities and is extending to the Texas facilities now.

VA and DOD plan to expand bidirectional exchanges to other large sites where patients move back and forth between the organizations, as well as to locations that hear benefit claims. For example, later in the summer, the Landstuhl Regional Medical Center in Germany will get BHIE installation, so VA authorized users will have access to clinical data for service members being treated in Germany from the warfront, Dunham said.

The bidirectional system builds on the existing infrastructure of the one-way Federal Health Information Exchange, which DOD and VA developed to streamline tracking of soldiers leaving active duty.

The system stores data on an Oracle9i database. VA hosts the technologies and repositories as well as the software that correlates the data between the two. 'The real-time bidirectional piece came directly from the feedback that military and VA health systems staff gave to us about FHIE. The historical [capability] was good, but now we have these other business needs,' Dunham said.

DOD used Extensible Markup Language and Web services to link with the VA framework and engineered the real-time connection via a virtual private network at the DOD-VA joint government computing facility.